Giant erosive spinal schwannomas: surgical management.

ABSTRACT

Giant erosive spinal schwannomas can be distinguished from other spinal schwannomas by its growth in myofascial planes and vertebral body erosion. Therapeutic radical tumour excision without neurologic deterioration is possible in the management. Prognosis is good after total tumour removal. In this article, it is aimed to report six patients who were diagnosed as giant erosive spinal schwannomas between 2001 and 2004 according to the criteria of Sridhar et al. Three of the patients were male and three female with the age range of 16-63 (mean age 39.7). Three of the tumours were located in the cervical region, one in the lumbar region, one in the thoracic region and one in the sacral region. Total excision of the tumours was achieved in four patients. However, one additional operation was required in two patients. Follow-up periods ranged from 6 weeks to 7 years (mean follow-up 51 months). Four patients had a good clinical outcome and there were no radiologic signs of instability or recurrence. Our experience and other published literature suggest that giant erosive spinal schwannoma has significant features such as local invasive nature together with vertebral body erosion and large size but benign histology, long duration for clinical presentation, common preoperative misdiagnosis and good prognosis after total excision. These tumours rarely need spinal instrumentation because the disc capsule and ligaments remain intact even if the pedicle and posterior elements are compromised.